For treating broken bones, particularly for setting bones or bone fragments, a number of osteosynthetic devices are available to the surgeon.
In recent years, a trend from conservative to operative surgical fracture treatment has been clearly evident. At the beginning of operative fracture treatment, optimum reconstruction of the fracture was in the foreground. No great attention was paid to the blood supply and the soft parts around the fracture. Efforts were made to achieve total stability without consideration for biology. With the spread of intramedullar nailing, it was recognized that total stability of the fracture is not absolutely necessary. Despite somewhat greater instability of the fracture, the minimally disrupted biology could heal the fracture. This new knowledge was also taken into consideration in other types of osteosynthesis. In plate osteosynthesis, for example, fewer screws and smaller and shorter plates are used. The same applies to external fixation devices. Instead of huge multi-dimensional structures with interfragment tension bolts, the simple unilateral setting device became accepted.
Despite the "biological" use of the external fixation device, the fracture does not always heal. This means that the fracture must often be treated with a second operation and another osteosynthetic method. The principal reason for complications are the nails or screws that are driven from outside through the skin and the soft tissue into the bone. Along these nails or screws, germs get into the bone, which leads to what is known as a "pintrak infection." If such an infection occurs, the nails or screws must be removed. While the infection is healing, which takes about ten days, the fracture cannot be set by means of an operation. The consequence is that during this period the patient must be immobilized.
In addition to this risk of infection with customary external setting devices, another disadvantage is becoming more apparent. Measurements with doppler lasers, with which the blood circulation in the bone can be clinically measured, have shown that inserting nails or screws causes a considerable disruption in the circulation in the bone. This means that in inserting external fixation devices, nails, or screws, the surgeon is already creating the next stage in the treatment (including the risk of Pintrak infection and ten-day immobilization of the patient for change of procedure). This has negative effects when, because of time factors, or for treatment of damage to soft tissue, the external setting device is temporarily used. In the case of a catastrophe, such as an airplane crash or railroad accident, injured persons must be treated as quickly as possible. For such cases the external setting device is excellent. Here too, however, the above-described problems will arise.